Non-surgical aesthetic treatments are becoming increasingly popular because they are quicker, less painful and more subtle than plastic surgery. Injection of dermal fillers is one of the most commonly performed aesthetic procedures and is used for wrinkle treatment, lip enhancement, cheek augmentation and scar removal. However, in some case, serious complications can occur such as misplacement of the filler, overcorrection of areas such as the nose, or the formation of nodules. In case of the most widely used hyaluronic acid (HA) fillers, hyaluronidase can be used to enzymatically decompose and eliminate the hyaluronic acid polymers that cause the complications.
The use of hyaluronidase has, however, several drawbacks. First, it is not approved for filler correction or reversal (off-label use). In fact, its use is even banned in some countries. Furthermore, because of its animal origin, hyaluronidase has been shown to cause allergic reactions and cases of severe angioedema have been described. In addition, the enzymatic degradation of fillers, especially in case of high volumizing fillers that are typically highly crosslinked, is often not fast enough for optimum convenience and control. Moreover, fillers based on polysaccharides other than HA, such as Radiesse® (CMC) or Novabel® (alginate), cannot be degraded using hyaluronidase.